Provider Demographics
NPI:1366449191
Name:SCHREI BROADT, CATHERINE (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:SCHREI BROADT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4059 JANDY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2167
Mailing Address - Country:US
Mailing Address - Phone:484-503-6450
Mailing Address - Fax:484-503-6445
Practice Address - Street 1:4059 JANDY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8893
Practice Address - Country:US
Practice Address - Phone:610-759-1200
Practice Address - Fax:610-759-4590
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008457L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1509643Medicaid
PA1509643Medicaid
G43428Medicare UPIN